Survival After Fulminant Myocarditis Induced by Immune-Checkpoint Inhibitors

Letters7 November 2017Survival After Fulminant Myocarditis Induced by Immune-Checkpoint InhibitorsDimitri Arangalage, MD*, Julie Delyon, MD*, Mathilde Lermuzeaux, MD, Kenneth Ekpe, MD, Stéphane Ederhy, MD, Cécile Pages, MD, and Céleste Lebbé, MD, PhDDimitri Arangalage, MD*From Assistance Publique–Hôpitaux de Paris, Bichat-Claude Bernard Hospital, Saint-Louis Hospital, and Saint-Antoine Hospital; Université Paris Diderot; Sorbonne Paris Cité; and Institut National de la Santé et de la Recherche Médicale, Paris, France., Julie Delyon, MD*From Assistance Publique–Hôpitaux de Paris, Bichat-Claude Bernard Hospital, Saint-Louis Hospital, and Saint-Antoine Hospital; Université Paris Diderot; Sorbonne Paris Cité; and Institut National de la Santé et de la Recherche Médicale, Paris, France., Mathilde Lermuzeaux, MDFrom Assistance Publique–Hôpitaux de Paris, Bichat-Claude Bernard Hospital, Saint-Louis Hospital, and Saint-Antoine Hospital; Université Paris Diderot; Sorbonne Paris Cité; and Institut National de la Santé et de la Recherche Médicale, Paris, France., Kenneth Ekpe, MDFrom Assistance Publique–Hôpitaux de Paris, Bichat-Claude Bernard Hospital, Saint-Louis Hospital, and Saint-Antoine Hospital; Université Paris Diderot; Sorbonne Paris Cité; and Institut National de la Santé et de la Recherche Médicale, Paris, France., Stéphane Ederhy, MDFrom Assistance Publique–Hôpitaux de Paris, Bichat-Claude Bernard Hospital, Saint-Louis Hospital, and Saint-Antoine Hospital; Université Paris Diderot; Sorbonne Paris Cité; and Institut National de la Santé et de la Recherche Médicale, Paris, France., Cécile Pages, MDFrom Assistance Publique–Hôpitaux de Paris, Bichat-Claude Bernard Hospital, Saint-Louis Hospital, and Saint-Antoine Hospital; Université Paris Diderot; Sorbonne Paris Cité; and Institut National de la Santé et de la Recherche Médicale, Paris, France., and Céleste Lebbé, MD, PhDFrom Assistance Publique–Hôpitaux de Paris, Bichat-Claude Bernard Hospital, Saint-Louis Hospital, and Saint-Antoine Hospital; Université Paris Diderot; Sorbonne Paris Cité; and Institut National de la Santé et de la Recherche Médicale, Paris, France.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/L17-0396 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Some patients with metastatic melanoma live longer when they are treated with combinations of immune-checkpoint inhibitors (1, 2). However, up to 55% of these patients experience high-grade, immune-related adverse events (3–5). In phase 3 trials of these drugs, immune-related adverse events involving the heart affected only 0.19% of patients; fulminant myocarditis was the most serious of these (5).Objective: To report what we believe to be the first patient to survive fulminant myocarditis induced by immune-checkpoint inhibitors.Case Report: We admitted a 35-year-old woman with unresectable stage IIIc melanoma of the neck who developed progressive dyspnea 15 days after ...References1. Hodi FS, Chesney J, Pavlick AC, Robert C, Grossmann KF, McDermott DF, et al. Combined nivolumab and ipilimumab versus ipilimumab alone in patients with advanced melanoma: 2-year overall survival outcomes in a multicentre, randomised, controlled, phase 2 trial. Lancet Oncol. 2016;17:1558-68. [PMID: 27622997] doi:10.1016/S1470-2045(16)30366-7 CrossrefMedlineGoogle Scholar2. Larkin J, Chiarion-Sileni V, Gonzalez R, Grob JJ, Cowey CL, Lao CD, et al. Combined nivolumab and ipilimumab or monotherapy in untreated melanoma. N Engl J Med. 2015;373:23-34. [PMID: 26027431] doi:10.1056/NEJMoa1504030 CrossrefMedlineGoogle Scholar3. Johnson DB, Balko JM, Compton ML, Chalkias S, Gorham J, Xu Y, et al. Fulminant myocarditis with combination immune checkpoint blockade. N Engl J Med. 2016;375:1749-55. [PMID: 27806233] CrossrefMedlineGoogle Scholar4. Wang DY, Okoye GD, Neilan TG, Johnson DB, Moslehi JJ. Cardiovascular toxicities associated with cancer immunotherapies. Curr Cardiol Rep. 2017;19:21. [PMID: 28220466] doi:10.1007/s11886-017-0835-0 CrossrefMedlineGoogle Scholar5. Ederhy S, Voisin A-L, Champiat S. Myocarditis with immune checkpoint blockade [Letter]. N Engl J Med. 2017;376:290-1. [PMID: 28102662] doi:10.1056/NEJMc1615251 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Assistance Publique–Hôpitaux de Paris, Bichat-Claude Bernard Hospital, Saint-Louis Hospital, and Saint-Antoine Hospital; Université Paris Diderot; Sorbonne Paris Cité; and Institut National de la Santé et de la Recherche Médicale, Paris, France.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L17-0396.* Drs. Arangalage and Delyon contributed equally to this work. 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